Referral management involves receiving, validating, and assigning patient referrals to clinicians. Manual processing creates delays, duplicate entries, and insurance verification bottlenecks that slow patient intake.
Automation extracts referral data from incoming documents, verifies insurance eligibility in real time, and assigns cases to clinicians based on availability and specialty. Patients are scheduled faster and referrers receive status updates automatically.
The full workflow, from trigger to completion.
Email, fax, or web form submission triggers the automation. The referral document is captured and routed to the extraction.
The automation reads the referral document, extracts patient name, date of birth, contact details, referral reason, and referring provider, and logs the data.
Automation queries to confirm the patient is not already in the system or does not have an active referral for the same condition.
Automation calls an insurance verification API or checks a third-party eligibility service to confirm coverage. If coverage is confirmed, the referral moves forward. If not, a manual review step is triggered.
Automation selects the best-fit clinician based on specialty, availability, and current workload, and assigns the referral.
Automation sends a message to the assigned clinician with referral details and a link to the patient record.
Automation sends an email to the referring provider confirming receipt of the referral and providing an estimated appointment date.
Automation updates the referral status to 'Assigned' and sets a follow-up reminder for the clinician to schedule the appointment within 2 business days.
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